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Li Z, Wang H, Lu F. The development, feasibility and credibility of intra-abdominal pressure measurement techniques: A scoping review. PLoS One 2024; 19:e0297982. [PMID: 38512833 PMCID: PMC10956852 DOI: 10.1371/journal.pone.0297982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/14/2024] [Indexed: 03/23/2024] Open
Abstract
AIM To provide a comprehensive overview on emerging direct and alternative methods for intra-abdominal pressure (IAP) measurement techniques. METHODS This was a scoping review study following Arksey and Malley's framework. The PubMed, EMBASE, Web of Science, EBSCO, Scopus and ProQuest databases were searched, and we only considered studies published from 2000 as we have extended the data from two previous reviews. Original studies that reported on the development, feasibility and credibility of IAP measurement techniques were included. RESULTS Forty-two of 9954 screened articles were included. IAP measurement techniques include three major categories: direct, indirect and less invasive measurement techniques. Agreement analyses were performed in most studies, and some explored the safety, time expenditure and reproducibility of IAP measurement techniques. CONCLUSIONS Clinical data assessing the validation of new IAP measurement techniques or the reliability of established measurement techniques remain lacking. Considering the cost and invasiveness, direct measurement is not recommended as a routine method for IAP measurement and should be preserved for critically ill patients where standard techniques are contraindicated or could be inaccurate. The measurement accuracy, reliability and sensitivity of the transrectal and transfemoral vein methods remain insufficient and cannot be recommended as surrogate IAP measures. Transvesical measurement is the most widely used method, which is the potentially most easy applicable technique and can be used as a reliable method for continuous and intermittent IAP measurement. Wireless transvaginal method facilitates the quantitative IAP measurement during exercise and activity, which laying the foundations for monitoring IAP outside of the clinic environment, but the accuracy of this technique in measuring absolute IAP cannot be determined at present. Less invasive technology will become a new trend to measure IAP and has substantial potential to replace traditional IAP measurement technologies, but further validation and standardization are still needed. Medical professionals should choose appropriate measurement tools based on the advantages and disadvantages of each IAP technique in combination with assessing specific clinical situations.
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Affiliation(s)
- ZhiRu Li
- Nursing Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - HuaFen Wang
- Nursing Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - FangYan Lu
- Hepatobiliary and pancreatic surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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2
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Niederauer S, Hunt G, Foreman KB, Merryweather A, Hitchcock R. Intrinsic factors contributing to elevated intra-abdominal pressure. Comput Methods Biomech Biomed Engin 2023; 26:941-951. [PMID: 35837994 PMCID: PMC9840719 DOI: 10.1080/10255842.2022.2100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/02/2022] [Accepted: 06/22/2022] [Indexed: 01/18/2023]
Abstract
Pelvic floor disorders affect 24% of US women, and elevated intra-abdominal pressure may cause pelvic injury through musculoskeletal strain. Activity restrictions meant to reduce pelvic strain after traumatic events, such as childbirth, have shown little benefit to patients. Reported high variability in abdominal pressure suggests that technique plays a substantial role in pressure generation. Understanding these techniques could inform evidence-based recommendations for protective pelvic care. We hypothesized use of a motion-capture methodology could identify four major contributors to elevated pressure: gravity, acceleration, abdominal muscle contraction, and respiration. Twelve women completed nineteen activities while instrumented for whole body motion capture, abdominal pressure, hip acceleration, and respiration volume. Correlation and partial least squares regression were utilized to determine primary technique factors that increase abdominal pressure. The partial least squares model identified two principal components that explained 59.63% of relative intra-abdominal pressure variability. The first component was primarily loaded by hip acceleration and relative respiration volume, and the second component was primarily loaded by flexion moments of the abdomen and thorax. While reducing abdominal muscle use has been a primary strategy in protective pelvic floor care, the influence of hip acceleration and breathing patterns should be considered with similar importance in future work.
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Affiliation(s)
- Stefan Niederauer
- Department of Biomedical Engineering, University of Utah, Salt Lake City, United States
| | - Grace Hunt
- Department of Mechanical Engineering, University of Utah, Salt Lake City, United States
| | - K Bo Foreman
- Department of Mechanical Engineering, University of Utah, Salt Lake City, United States
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, United States
| | - Andrew Merryweather
- Department of Mechanical Engineering, University of Utah, Salt Lake City, United States
| | - Robert Hitchcock
- Department of Biomedical Engineering, University of Utah, Salt Lake City, United States
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3
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Hendrycks R, Yang M, Hitchcock R, Leitner M, Niederauer S, Nygaard IE, Sheng X, Shaw JM. Temporal trends in trunk flexor endurance and intra-abdominal pressure in postpartum women. Physiother Theory Pract 2021; 37:1217-1226. [PMID: 31686567 PMCID: PMC7198326 DOI: 10.1080/09593985.2019.1686792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 07/12/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
Objectives: To describe change in trunk flexor endurance and intra-abdominal pressure (IAP) associated with trunk flexor assessment and explore factors associated with change in trunk flexor endurance during the first postpartum year.Design: Ancillary analysis of an ongoing prospective cohort study.Methods: Participants (N = 282) were primiparous women delivered vaginally. They completed trunk flexor endurance testing while assessing IAP, body habitus measures (body mass index, waist circumference, and body composition), and questionnaires 5-10 weeks and 11-15 months postpartum. We investigated change in trunk flexor endurance by quartile of improvement and factors associated with improvement (Q4 vs. Q1-Q3) using multivariable models, adjusted for baseline endurance.Results: Mean age was 28 ± 5 years. The median (IQR) trunk flexor hold time increased from early to late postpartum (129/IQR = 68, 217 vs 148/IQR = 80, 265 seconds, p = .01) and mean (SD) IAP decreased (55/SD = 13 vs 48/SD = 14 cmH20, p < .0001). The most improved group (Q4) increased endurance time by 176 seconds (95% CI = 103, 254), were less likely to be Hispanic, more likely to be older, more educated, and have lower measures of body habitus than women in Q1-Q3. Conclusion: Trunk flexor endurance increased and IAP decreased over one year postpartum. Lower body habitus and higher age early postpartum predicted greatest improvement in trunk flexor endurance at 1 year.
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Affiliation(s)
- Russell Hendrycks
- Department of Health, Kinesiology, and Recreation, 250 S. 1850 E. Room 241, University of Utah, Salt Lake City, UT, 84112
| | - Meng Yang
- Department of Family and Preventive Medicine, 375 Chipeta Way Ste. A, University of Utah, Salt Lake City, UT, 84108
| | - Robert Hitchcock
- Department of Biomedical Engineering, 36 S. Wasatch Drive, University of Utah, Salt Lake City, UT, 84112
| | - Monika Leitner
- Department of Health Professions, Murtenstrasse 10, Bern University of Applied Sciences, CH-3008 Bern, Switzerland
| | - Stefan Niederauer
- Department of Biomedical Engineering, 36 S. Wasatch Drive, University of Utah, Salt Lake City, UT, 84112
| | - Ingrid E. Nygaard
- Department of Obstetrics and Gynecology, 30 N. 1900 E. Room 2B200, University of Utah, Salt Lake City, UT, 84132
| | - Xiaoming Sheng
- College of Nursing, 10 S. 2000 E., University of Utah, Salt Lake City, UT, 84112
| | - Janet M. Shaw
- Department of Health, Kinesiology, and Recreation, 250 S. 1850 E. Room 241, University of Utah, Salt Lake City, UT, 84112
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Wolpern AE, de Gennaro JD, Brusseau TA, Byun W, Egger MJ, Hitchcock RW, Nygaard IE, Sheng X, Shaw JM. Relationship of heart rate, perceived exertion, and intra-abdominal pressure in women. ACTA ACUST UNITED AC 2021; 9:97-103. [PMID: 34532155 DOI: 10.31189/2165-6193-9.3.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Exercise increases intra-abdominal pressure (IAP) acutely, which may impact the pelvic floor of women. IAP during exercise demonstrates high variability among women but is not routinely assessed. Assessing less invasive measures related to IAP during exercise may facilitate study of how IAP impacts the pelvic floor. Methods The objective of this study was to investigate the relationship of heart rate and rating of perceived exertion (RPE) with IAP during a standard treadmill test. We describe the trend of IAP by predicted aerobic fitness during incremental exercise. IAP was measured using a validated transducer placed in the upper vagina. Heart rate and RPE were collected during the first 3 stages of the standard Bruce treadmill protocol. Relationships of heart rate and RPE with IAP were determined by Pearson correlation coefficients. Predicted aerobic fitness values for each participant were ranked in tertiles with IAP by treadmill stage. Results Twenty-four women participated in this study (mean age: 24.7 (5.4) years; body mass index: 22.5 (2.2) kg/m2). There were significant relationships between heart rate and IAP (r= 0.67, p < 0.001) and RPE and IAP (r= 0.60, p < 0.001) across treadmill stages. Tertiles of predicted aerobic fitness and IAP displayed similar trends as other exercise measures during incremental exercise, such as, heart rate and ventilation. Conclusion Heart rate and RPE could be used as proxy measures of IAP during incremental exercise. Aerobic fitness may help explain IAP variability in women and provide context for future research on IAP and pelvic floor health.
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Affiliation(s)
- Ali E Wolpern
- Department of Health, Kinesiology, and Recreation, University of Utah College of Health, Salt Lake City, United States
| | - Johanna D de Gennaro
- Department of Biomedical Engineering, University of Utah College of Engineering, Salt Lake City, United States
| | - Timothy A Brusseau
- Department of Health, Kinesiology, and Recreation, University of Utah College of Health, Salt Lake City, United States
| | - Wonwoo Byun
- Department of Health, Kinesiology, and Recreation, University of Utah College of Health, Salt Lake City, United States
| | - Marlene J Egger
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, United States
| | - Robert W Hitchcock
- Department of Biomedical Engineering, University of Utah College of Engineering, Salt Lake City, United States
| | - Ingrid E Nygaard
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, United States
| | - Xiaoming Sheng
- University of Utah College of Nursing, Salt Lake City, United States
| | - Janet M Shaw
- Department of Health, Kinesiology, and Recreation, University of Utah College of Health, Salt Lake City, United States
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Marriott J, Pedofsky L, Smalldridge J, Hayward L, Budgett D, Nielsen PMF, Kruger J. Assessing vaginal pressure profiles before and after prolapse surgery using an intravaginal pressure sensor (femfit®). Int Urogynecol J 2020; 32:3037-3044. [PMID: 33196880 DOI: 10.1007/s00192-020-04576-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The impact of surgery on pelvic floor muscle (PFM) function remains uncertain. There is a pressure differential along the length of the vagina, influenced by surrounding active and passive tissue structures, giving rise to a pressure profile. The aim of this study is to determine if an intravaginal pressure sensor, femfit®, can measure differences in pressure profiles before and after surgery for pelvic organ prolapse (POP). METHODS This pilot study includes 22 women undergoing POP surgery. Intravaginal pressure profiles were measured with femfit® pre- and post-surgery and differences tested using paired Student's t-tests. Patients completed validated questionnaires for vaginal, bowel, and urinary incontinence symptoms pre- and post-POP surgery and a femfit® usability questionnaire. RESULTS Sixteen sets of vaginal pressure data were analysed. The highest pressure generated was identified as the peak PFM pressure, whilst all sensor measurements provided a pressure profile. Intra-abdominal pressure (IAP) was measured by the most distal sensor, 8. On average, the difference between peak PFM pressure and IAP was significantly greater post-surgery (p < 0.01). Urinary and vaginal symptom questionnaire scores were significantly improved after POP surgery. Femfit® usability questionnaires demonstrated high levels of patient acceptability. CONCLUSIONS Women generate higher peak PFM pressures compared to IAP post-POP surgery, with pressure profiles that are comparable to women without POP. This metric might be useful to assess the outcome of POP surgery and encourage women to maintain this profile via PFM training, potentially reducing POP recurrence risk.
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Affiliation(s)
- Joy Marriott
- Department of Obstetrics & Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, Auckland, 92019, New Zealand.
| | - Laura Pedofsky
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | - Lynsey Hayward
- Middlemore Hospital CMDHB, University of Auckland, Auckland, New Zealand
| | - David Budgett
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Poul M F Nielsen
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Jennifer Kruger
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Do Measures of Muscular Fitness Modify the Effect of Intra-abdominal Pressure on Pelvic Floor Support in Postpartum Women? Female Pelvic Med Reconstr Surg 2020; 27:e267-e276. [PMID: 32657824 DOI: 10.1097/spv.0000000000000901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to determine whether measures of muscular fitness modify the effect of intra-abdominal pressure (IAP) during lifting on pelvic floor support. METHODS Participants, primiparous women 1 year after vaginal delivery, underwent the Pelvic Organ Prolapse Quantification examination, measurement of IAP via a vaginal sensor while lifting a weighted car seat, pelvic floor muscle force assessment using an instrumented speculum, grip strength using a hand dynamometer, and trunk flexor endurance by holding an isometric contraction while maintaining a 60-degree angle to the table. We dichotomized pelvic floor support as worse (greatest descent of the anterior, posterior, or apical vagina during maximal strain at or below the hymen) versus better (all points above the hymen). RESULTS Of 825 participants eligible after delivery, 593 (71.9%) completed a 1-year study visit. Mean (SD) age was 29.6 (5.0) years. One year postpartum, 55 (9.3%) demonstrated worse support. There were no differences in IAP during lifting or in other measures of pelvic floor loading between women with better and worse support. In multivariable analyses, neither grip strength nor pelvic floor muscle force modified the effect of IAP on support. In women with trunk flexor endurance duration ≥13 minutes, the odds of worse support increased significantly as IAP increased. No fitness measure modified the effect of other measures of pelvic floor loading on support. CONCLUSIONS Primiparous women with higher IAP during lifting and greater muscular fitness did not have reduced odds of worse pelvic floor support compared with those with lower IAP at the same muscular fitness.
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Moss W, Shaw JM, Yang M, Sheng X, Hitchcock R, Niederauer S, Packer D, Nygaard IE. The Association Between Pelvic Floor Muscle Force and General Strength and Fitness in Postpartum Women. Female Pelvic Med Reconstr Surg 2020; 26:351-357. [PMID: 30921083 PMCID: PMC6764904 DOI: 10.1097/spv.0000000000000718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of the study was to determine whether measures of muscular strength and fitness are associated with pelvic floor muscle (PFM) force 1-year postpartum in a population of primiparous women who delivered vaginally. METHODS This cross-sectional analysis is an ancillary study to an ongoing prospective cohort study and includes 203 primiparous women. Procedures collected 1-year postpartum included maximal PFM force, grip strength, trunk flexor muscle endurance, percent body fat, intra-abdominal pressure during trunk flexor endurance testing, intra-abdominal pressure during strain, and self-reported physical activity. RESULTS The mean (SD) age was 29.8 (5.0) years and the mean (SD) body mass index was 24.5 (5.2) kg/m. Nineteen percent were of Hispanic ethnicity. The median (interquartile range) PFM force was 5.05 (2.86-7.94) N. The median (interquartile range) trunk flexor endurance time was 146.0 (78.0-267.0), whereas the mean (SD) grip strength and percent fat were 32.4 (6.4) kg and 29.4% (10.0), respectively.There were no statistically significant associations between PFM force and any of the measures tested on analyses unadjusted or adjusted for self-report of doing PFM exercises. Of other factors evaluated, non-Hispanic ethnicity, increasing age, self-reported family history of pelvic organ prolapse or urinary incontinence, and normal and obese body mass index (both compared with overweight) were associated with lower PFM force. CONCLUSIONS In primiparous women 1-year postpartum, we found no associations between PFM force and measures of strength and fitness. This study's results are consistent with existing literature that specific, targeted, and consistent pelvic floor exercises are the best way to improve PFM strength.
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Affiliation(s)
| | - Janet M. Shaw
- Department of Health, Kinesiology, and Recreation, University of Utah, College of Health,
| | - Meng Yang
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT,
| | - Xiaoming Sheng
- College of Nursing, University of Utah, Salt Lake City, UT,
| | - Robert Hitchcock
- Department of Bioengineering, University of Utah, Salt Lake City, UT,
| | | | - Diane Packer
- Department of Physical Therapy, University of Utah College of Health,
| | - Ingrid E. Nygaard
- Department of Obstetrics and Gynecology, University of Utah School of Medicine,
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8
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Intra-abdominal Pressure and Pelvic Floor Health: Should We Be Thinking About This Relationship Differently? Female Pelvic Med Reconstr Surg 2020; 26:409-414. [DOI: 10.1097/spv.0000000000000799] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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9
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de Gennaro JD, de Gennaro CK, Shaw JM, Petelenz TJ, Nygaard IE, Hitchcock RW. The Relationship Between Intra-Abdominal Pressure and Body Acceleration During Exercise. Female Pelvic Med Reconstr Surg 2019; 25:231-237. [PMID: 29135811 PMCID: PMC5949233 DOI: 10.1097/spv.0000000000000523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES High intra-abdominal pressure (IAP) may influence the development of pelvic floor disorders. We and others have used intravaginal pressure transducers to measure IAP in women during exercise and daily activities, but utilizing the transducer for long-term measurements creates compliance issues. Waist-worn accelerometers are prominent in research and may be a reliable alternative for approximating IAP. We hypothesized that there are pair-wise positive correlations between the mean maximal accelerometer vector magnitude and 2 IAP measurements: mean maximal IAP and area under the curve (AUC). METHODS Twenty-five women who regularly participated in exercise performed 13 activities. Intra-abdominal pressure was measured with an intravaginal transducer and acceleration with a waist-worn accelerometer. We determined the mean maximal IAP, AUC for IAP, and mean maximal accelerometer vector magnitude for each activity and participant. The relationship between IAP and acceleration was determined by computing the Pearson correlation coefficient (R) and the 95% confidence interval for mean maximal accelerometer vector magnitude versus mean maximal IAP and mean maximal accelerometer vector magnitude versus AUC for IAP. RESULTS The R values were 0.7353 for mean maximal accelerometer vector magnitude versus mean maximal IAP (including walking) and 0.5059 for mean maximal accelerometer vector magnitude versus AUC for IAP (excluding walking). Walking at 3 speeds, analyzed separately, presented R values of 0.72208 for mean maximal IAP and 0.21678 for AUC. CONCLUSION Waist-worn accelerometers may provide a viable method for approximating mean maximal IAP in a population of women during most activities.
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Affiliation(s)
| | | | - Janet M Shaw
- Department of Health, Kinesiology, and Recreation, and
| | | | - Ingrid E Nygaard
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
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Parkinson LA, Rosamilia A, Mukherjee S, Papageorgiou AW, Melendez-Munoz J, Werkmeister JA, Gargett CE, Arkwright JW. A fiber-optic sensor-based device for the measurement of vaginal integrity in women. Neurourol Urodyn 2019; 38:2264-2272. [PMID: 31385355 DOI: 10.1002/nau.24130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 07/22/2019] [Indexed: 02/05/2023]
Abstract
AIMS Pelvic floor disorders (PFDs) in women are a major public health concern. Current clinical methods for assessing PFDs are either subjective or confounded by interference from intra-abdominal pressure (IAP). This study introduces an intravaginal probe that can determine distributed vaginal pressure during voluntary exercises and measures the degree of vaginal tissue support independent of IAP fluctuations. METHODS An intravaginal probe was fabricated with 18 independent fiber-optic pressure transducers positioned along its upper and lower blades. Continuous pressure measurement along the anterior and posterior vaginal walls during the automated expansion of the probe enabled the resistance of the tissue to be evaluated as a function of displacement, in a manner reflecting the elastic modulus of the tissue. After validation in a simulated vaginal phantom, in vivo measurements were conducted in the relaxed state and during a series of voluntary exercises to gauge the utility of the device in women. RESULTS The probe reliably detected variations in the composition of sub-surface material in the vaginal phantom. During in-vivo measurements the probe detected distributed tissue elasticity in the absence of IAP change. In addition, the distribution of pressure along both anterior and posterior vaginal walls during cough, Valsalva and pelvic floor contraction was clearly resolved with a large variation observed between subjects. CONCLUSIONS Our data highlight the potential for the probe to assess the integrity of the vagina wall and support structures as an integrated functional unit. Further in vivo trials are needed to correlate data with clinical findings to assist in the assessment of PFDs.
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Affiliation(s)
- Luke A Parkinson
- College of Science and Engineering, Flinders University, Tonsley, South Australia, Australia
| | - Anna Rosamilia
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,Monash Health Hospital & Health Care, Clayton, Victoria, Australia
| | - Shayanti Mukherjee
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Anthony W Papageorgiou
- College of Science and Engineering, Flinders University, Tonsley, South Australia, Australia
| | | | - Jerome A Werkmeister
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Caroline E Gargett
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - John W Arkwright
- College of Science and Engineering, Flinders University, Tonsley, South Australia, Australia
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11
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Variables Affecting Intra-abdominal Pressure During Lifting in the Early Postpartum Period. Female Pelvic Med Reconstr Surg 2019; 24:287-291. [PMID: 28727649 DOI: 10.1097/spv.0000000000000462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Intra-abdominal pressure (IAP) may contribute to pelvic floor health, although the direction and magnitude of such an effect, if any, are not yet known. Identifying individual characteristics, and in particular modifiable factors, associated with higher IAP during recovery from vaginal childbirth might serve to mitigate early pelvic floor dysfunction. The aim of this study was to identify characteristics associated with maximal IAP during lifting in postpartum primiparous women who delivered vaginally. METHODS At 6 to 10 weeks postpartum, we measured maximal IAP, assessed via an upper vaginal sensor, as participants (enrolled in an ongoing cohort study) lifted a weighted car seat (12.5 kg). We evaluated whether the following independent variables were associated with maximal IAP: age, ethnicity, body mass index, height, abdominal circumference, weight gain during pregnancy, lifting time, breath holding during lifting, lifting technique, measures of muscular fitness, and days since delivery. RESULTS In the 206 participants, weight, waist circumference, body mass index, and days since delivery were positively associated with mean maximal IAP during lifting, whereas IAP decreased as height increased. As the duration of the lifting task increased, mean maximal IAP during lifting also increased, but there were no associations between lifting technique or breath holding during lifting and IAP. Neither pelvic floor muscle strength nor abdominal muscle endurance was associated with IAP during lifting. CONCLUSIONS Other than measures of body habitus and lifting duration, we did not identify modifiable factors that could mitigate maximal pressures experienced by the pelvic floor during the early postpartum period.
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Thibault-Gagnon S, Auchincloss C, Graham R, McLean L. The temporal relationship between activity of the pelvic floor muscles and motion of selected urogenital landmarks in healthy nulliparous women. J Electromyogr Kinesiol 2018; 38:126-135. [DOI: 10.1016/j.jelekin.2017.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/17/2017] [Accepted: 11/28/2017] [Indexed: 12/11/2022] Open
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Niederauer S, de Gennaro J, Nygaard I, Petelenz T, Hitchcock R. Development of a novel intra-abdominal pressure transducer for large scale clinical studies. Biomed Microdevices 2017; 19:80. [PMID: 28844111 DOI: 10.1007/s10544-017-0211-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Intra-abdominal pressure may be one of the few modifiable risk factors associated with developing a pelvic floor disorder. With one in eight women having surgery to correct a pelvic floor disorder in their lifetimes, intra-abdominal pressure may be a key to understanding the disease etiology and how to mitigate its occurrence and progression. Many traditional methods of intra-abdominal pressure measurement have limitations in data quality, environment of use, and patient comfort. We have modified a previously reported intravaginal pressure transducer that has been shown to overcome other intra-abdominal pressure measurement technique limitations (Coleman et al. 2012). Our modifications to the intravaginal pressure transducer make it easier to use, less costly, and more reliable than previous designs, while maintaining accuracy, integrity, and quality of data. This device has been used in over 400 participants to date as part of one of the most comprehensive studies examining the relationship between intra-abdominal pressure and pelvic floor disorders.
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Affiliation(s)
- Stefan Niederauer
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive Rm. 3100, Salt Lake City, UT, 84112, USA
| | - Johanna de Gennaro
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive Rm. 3100, Salt Lake City, UT, 84112, USA
| | - Ingrid Nygaard
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, 50 N. Medical Dr, Salt Lake City, UT, USA
| | - Tomasz Petelenz
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive Rm. 3100, Salt Lake City, UT, 84112, USA
| | - Robert Hitchcock
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive Rm. 3100, Salt Lake City, UT, 84112, USA.
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Nygaard IE, Clark E, Clark L, Egger MJ, Hitchcock R, Hsu Y, Norton P, Sanchez-Birkhead A, Shaw J, Sheng X, Varner M. Physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery: a protocol for a mixed-methods prospective cohort study. BMJ Open 2017; 7:e014252. [PMID: 28073797 PMCID: PMC5253561 DOI: 10.1136/bmjopen-2016-014252] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-funded Program Project, 'Bridging physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery', uses mixed-methods research to study the influences of intra-abdominal pressure, physical activity, body habitus and muscle fitness on pelvic floor support and symptoms as well as the cultural context in which women experience those changes. METHODS AND ANALYSIS Using quantitative methods, we will evaluate whether pelvic floor support and symptoms 1 year after the first vaginal delivery are affected by biologically plausible factors that may impact muscle, nerve and connective tissue healing during recovery (first 8 weeks postpartum) and strengthening (remainder of the first postpartum year). Using qualitative methods, we will examine cultural aspects of perceptions, explanations of changes in pelvic floor support, and actions taken by Mexican-American and Euro-American primipara, emphasising early changes after childbirth. We will summarise project results in a resource toolkit that will enhance opportunities for dialogue between women, their families and providers, and across lay and medical discourses. We anticipate enrolling up to 1530 nulliparous women into the prospective cohort study during the third trimester, following those who deliver vaginally 1 year postpartum. Participants will be drawn from this cohort to meet the project's aims. ETHICS AND DISSEMINATION The University of Utah and Intermountain Healthcare Institutional Review Boards approved this study. Data are stored in a secure password-protected database. Papers summarising the primary results and ancillary analyses will be published in peer-reviewed journals.
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Affiliation(s)
- Ingrid E Nygaard
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Erin Clark
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Lauren Clark
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Marlene J Egger
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Robert Hitchcock
- Department of Bioengineering, College of Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Yvonne Hsu
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Peggy Norton
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Janet Shaw
- Department of Health, Kinesiology, and Recreation, College of Health, University of Utah, Salt Lake City, Utah, USA
| | - Xiaoming Sheng
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Michael Varner
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Reproducibility of intra-abdominal pressure measured during physical activities via a wireless vaginal transducer. Female Pelvic Med Reconstr Surg 2016; 21:164-9. [PMID: 25730430 DOI: 10.1097/spv.0000000000000167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS In the urodynamics laboratory setting, a wireless pressure transducer, developed to facilitate research exploring intra-abdominal pressure (IAP) and pelvic floor disorders, was highly accurate. We aimed to study reproducibility of IAP measured using this transducer in women during activities performed in an exercise science laboratory. METHODS Fifty-seven women (mean ± SD, age 30.4 ±9.3 years; body mass index, 22.4 ± 2.68 kg/m) completed 2 standardized activity sessions using the same transducer at least 3 days apart. Pressure data for 31 activities were transmitted wirelessly to a base station and analyzed for mean net maximal IAP, area under the curve, and first moment of the area. Activities included typical exercises, lifting 13.6 to 18.2 kg, and simulated household tasks. Analysis for test-retest reliability included Bland-Altman plots with absolute limits of agreement, Wilcoxon signed rank tests to assess significant differences between sessions, intraclass correlations, and κ statistics to assess intersession agreement in highest versus other quintiles of maximal IAP. RESULTS Few activities exhibited significant differences between sessions in maximal IAP, or in area under the curve and first moment of the area values. For 13 activities, the agreement between repeat measures of maximal IAP was better than ±10 cm H20; for 20 activities, better than ±15 cm H20. The absolute limits of agreement increased with mean IAP. The highest quintile of IAP demonstrated fair/substantial agreement between sessions in 25 of 30 activities. CONCLUSIONS Reproducibility of IAP depends on the activity undertaken. Interventions geared toward lowering IAP should account for this, maximize efforts to improve IAP reproducibility.
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Coleman TJ, Nygaard IE, Holder DN, Egger MJ, Hitchcock R. Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm. Int Urogynecol J 2015; 26:1123-30. [PMID: 25672647 DOI: 10.1007/s00192-015-2638-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 01/22/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to describe the intra-abdominal pressures (IAP) generated during Pilates Mat and Reformer activities, and determine whether these activities generate IAP above a sit-to-stand threshold. METHODS Twenty healthy women with no symptomatic vaginal bulge, median age 43 (range 22-59 years), completed Pilates Mat and Reformer exercise routines each consisting of 11 exercises. IAP was collected by an intra-vaginal pressure transducer, transmitted wirelessly to a base station, and analyzed for maximal and area under the curve (AUC) IAP. RESULTS There were no statistically significant differences in the mean maximal IAP between sit-to-stand and any of the Mat or Reformer exercises in the study population. Six to twenty-five percent of participants exceeded their individual mean maximal IAP sit-to-stand thresholds for 10 of the 22 exercises. When measuring AUC from 0 cm H2O, half the exercises exceeded the mean AUC of sit-to-stand, but only Pilates Reformer and Mat roll-ups exceeded the mean AUC of sit-to-stand when calculated from a threshold of 40 cm H2O (consistent with, for example, walking). CONCLUSION Our results support recommending this series of introductory Pilates exercises, including five Mat exercises and six Reformer exercises to women desiring a low IAP exercise routine. More research is needed to determine the long-term effects of Pilates exercise on post-surgical exercise rehabilitation and pelvic floor health.
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Affiliation(s)
- Tanner J Coleman
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 4202, Salt Lake City, UT, 84112, USA
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Coleman TJ, Hamad NM, Shaw JM, Egger MJ, Hsu Y, Hitchcock R, Jin H, Choi CK, Nygaard IE. Effects of walking speeds and carrying techniques on intra-abdominal pressure in women. Int Urogynecol J 2014; 26:967-74. [PMID: 25527480 DOI: 10.1007/s00192-014-2593-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/27/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Walking speed and carrying technique affect intra-abdominal pressure (IAP) in women. In this study, we tested the feasibility of monitoring IAP outside the laboratory environment and compared IAP while study participants were (1) carrying 13.6 kg (similar to a 3-month old in car seat) in six different ways while walking 100 m; and (2) while walking 400 m at self-selected slow, normal, and fast paces. METHODS Forty-six healthy women between 19 and 54 years completed the walking and lifting activities; the order for each was randomized. IAP was monitored with an intravaginal pressure transducer that wirelessly transmitted pressure data to a portable base station. We analyzed maximal peak IAP and area under the curve (AUC) IAP. RESULTS Monitoring IAP outside of the laboratory was feasible. Mean maximal IAP during walking increased as pace increased: 42.5 [standard deviation (SD) 10.2], 50.5 (10.9), and 62.0 (12.1) cmH2O for slow, medium, and fast speeds, respectively: p < 0.0001 by mixed-model analysis of variance (ANOVA). The corresponding AUC of IAP for walking decreased as pace increased. The awkward carry, side carry, and front carry activities each resulted in higher mean maximal IAP [65.8 (10.6), 67.7 (12.8), and 77.3 (13.1) cmH2O, respectively] than the carry-in-backpack activity [55.5 (11.4) cmH2O; p < 0.0001]. CONCLUSION Subtle variations in walking speed or method of carrying a toddler-size load can produce significant changes in IAP. Whether these changes increase the risk of pelvic floor disorders is not yet clear. However, these data suggest that further inquiry into optimal methods and appliances to assist women in carrying may create a lower IAP profile.
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Affiliation(s)
- Tanner J Coleman
- Department of Bioengineering, University of Utah, 36 S. Wasatch Dr., Salt Lake City, UT, 84112, USA
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18
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Hamad NM, Shaw JM, Nygaard IE, Coleman TJ, Hsu Y, Egger M, Hitchcock RW. More complicated than it looks: the vagaries of calculating intra-abdominal pressure. J Strength Cond Res 2014; 27:3204-15. [PMID: 23439349 DOI: 10.1519/jsc.0b013e31828b8e4c] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Activities thought to induce high intra-abdominal pressure (IAP), such as lifting weights, are restricted in women with pelvic floor disorders. Standardized procedures to assess IAP during activity are lacking and typically only focus on maximal IAP variably defined. Our intent in this methods article is to establish the best strategies for calculating maximal IAP and to add area under the curve and first moment of the area as potentially useful measures in understanding biologic effects of IAP. Thirteen women completed a range of activities while wearing an intravaginal pressure transducer. We first analyzed various strategies heuristically using data from 3 women. The measure that seemed to best represent maximal IAP was an average of the 3, 5, or 10 highest values, depending on activity, determined using a top-down approach, with peaks at least 1 second apart using algorithms written for Matlab computer software, we then compared this strategy with others commonly reported in the literature quantitatively using data from 10 additional volunteers. Maximal IAP calculated using the top-down approach differed for some, but not all, activities compared with the single highest peak or to averaging all peaks. We also calculated area under the curve, which allows for a time component, and first moment of the area, which maintains the time component while weighing pressure amplitude. We validated methods of assessing IAP using computer-generated sine waves. We offer standardized methods for assessing maximal area under the curve and first moment of the area for IAP to improve future reporting and application of this clinically relevant measure in exercise science.
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Affiliation(s)
- Nadia M Hamad
- 1Department of Exercise and Sport Science, University of Utah College of Health, Salt Lake City, Utah; 2Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah; 3Department of Bioengineering, University of Utah, Salt Lake City, Utah; and 4Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
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Arora AS, Kruger JA, Budgett DM, Hayward LM, Smalldridge J, Nielsen PF, Kirton RS. Clinical evaluation of a high-fidelity wireless intravaginal pressure sensor. Int Urogynecol J 2014; 26:243-9. [DOI: 10.1007/s00192-014-2500-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
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Shaw JM, Hamad NM, Coleman TJ, Egger MJ, Hsu Y, Hitchcock R, Nygaard IE. Intra-abdominal pressures during activity in women using an intra-vaginal pressure transducer. J Sports Sci 2014; 32:1176-85. [PMID: 24575741 DOI: 10.1080/02640414.2014.889845] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Strenuous physical activity has been linked to pelvic floor disorders in women. Using a novel wireless intra-vaginal pressure transducer, intra-abdominal pressure was measured during diverse activities in a laboratory. Fifty-seven women performed a prescribed protocol using the intra-vaginal pressure transducer. We calculated maximal, area under the curve and first moment of the area intra-abdominal pressure for each activity. Planned comparisons of pressure were made between levels of walking and cycling and between activities with reported high pressure in the literature. Findings indicate variability in intra-abdominal pressure amongst individuals doing the same activity, especially in activities that required regulation of effort. There were statistically significant differences in maximal pressure between levels of walking, cycling and high pressure activities. Results for area under the curve and first moment of the area were not always consistent with maximal pressure. Coughing had the highest maximal pressure, but had lower area under the curve and first moment of the area compared to most activities. Our data reflect novel findings of maximal, area under the curve and first moment of the area measures of intra-abdominal pressure, which may have clinical relevance for how physical activity relates to pelvic floor dysfunction.
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Affiliation(s)
- Janet M Shaw
- a Department of Exercise and Sport Science , University of Utah , Salt Lake City , USA
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Design and development of a novel intra-vaginal pressure sensor. Int Urogynecol J 2013; 24:1715-21. [DOI: 10.1007/s00192-013-2097-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 03/16/2013] [Indexed: 10/26/2022]
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Nygaard IE, Hamad NM, Shaw JM. Activity restrictions after gynecologic surgery: is there evidence? Int Urogynecol J 2013; 24:719-24. [PMID: 23340879 DOI: 10.1007/s00192-012-2026-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 12/08/2012] [Indexed: 11/28/2022]
Abstract
Many surgeons recommend rest and restricting activities to their patients after surgery. The aim of this review is to summarize the literature regarding types of activities gynecologic surgeons restrict and intra-abdominal pressure during specific activities and to provide an overview of negative effects of sedentary behavior (rest). We searched PubMed and Scopus for years 1970 until present and excluded studies that described recovery of activities of daily living after surgery as well as those that assessed intra-abdominal pressure for other reasons such as abdominal compartment syndrome and hypertension. For our review of intra-abdominal pressure, we excluded studies that did not include a generally healthy population, or did not report maximal intra-abdominal pressures. We identified no randomized trial or prospective cohort study that studied the association between postoperative activity and surgical success after pelvic floor repair. The ranges of intra-abdominal pressures during specific activities are large and such pressures during activities commonly restricted and not restricted after surgery overlap considerably. There is little concordance in mean peak intra-abdominal pressures across studies. Intra-abdominal pressure depends on many factors, but not least the manner in which it is measured and reported. Given trends towards shorter hospital stays and off work intervals, which both predispose women to higher levels of physical activity, we urge research efforts towards understanding the role of physical activity on recurrence of pelvic organ prolapse and urinary incontinence after surgery.
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Affiliation(s)
- Ingrid E Nygaard
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 50 North Medical Drive, Salt Lake City, UT 84132-0001, USA.
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